What are common emergency department cases during New Year's Eve?

Common Emergency Department Cases During New Year's Eve

New Year's Eve is associated with a significant surge in assault-related injuries (particularly altercations and intimate partner violence), alcohol-related trauma, firework injuries, and motor vehicle crashes, requiring emergency departments to prepare for increased volumes and specific injury patterns during this high-risk holiday period.

Assault-Related Injuries

Altercations and intimate partner violence show the highest increase above baseline during the New Year's Eve period compared to all other holidays. 1

• New Year's Eve demonstrates the most significant elevation in assault-related ED visits among all holidays studied, with altercations being the predominant presentation. 1
• Intimate partner violence (IPV) remains significantly elevated during New Year's Eve and continues through the holiday period. 1
• Sexual assaults are significantly higher than baseline specifically during the New Year's Eve period, though they decrease during other winter holidays like Christmas. 1
• Male patients comprise approximately 70% of assault-related presentations, with a mean age of 34 years. 2
• Violent assaults account for approximately half of trauma presentations during high-risk periods. 2

Alcohol-Related Injuries and Intoxication

Alcohol consumption at even low levels (single drink) increases injury risk 3.3-fold, with a 10-fold increase at six or more drinks, making alcohol intoxication a dominant factor in New Year's Eve ED presentations. 3

• The risk of non-fatal injury begins with consumption of a single drink (OR = 3.3; 95% CI = 1.9-5.7) and escalates dramatically with higher consumption. 3
• Patients consuming six or more drinks in the preceding 6 hours have a 10-fold increased risk of injury. 3
• Critically, patients without alcohol dependence symptoms may be at higher risk of injury than those with dependence, requiring universal screening rather than targeting only known alcoholics. 3
• Intentional injuries (assaults) show higher association with alcohol use than unintentional injuries. 3
• Approximately 46% of intoxicated ED visits involve trauma, with mean blood alcohol levels around 245 mg%. 2

Critical Management Gap in Alcohol-Related Presentations

Despite extensive medical workup, only 12.5% of intoxicated patients are screened for dangerous behaviors (depression, suicide, homicide), and only 15% receive counseling about alcohol cessation. 2

• Emergency physicians perform an average of five tests or X-rays per intoxicated patient but fail to address the underlying substance abuse in 85% of cases. 2
• Only 13% receive referral to psychiatric services or alcohol rehabilitation despite the high prevalence of dangerous behaviors in this population. 2

Firework-Related Injuries

Firework injuries peak specifically on the first day of celebrations (New Year's Day), with burns being the most common injury type (65.7%), predominantly affecting hands, fingers, and face. 4

• The incidence peaks on specific days: the first day of celebration, fifth day, and last day of holiday periods. 4
• Males account for 87.9% of firework injuries, with a male-to-female ratio of 7.4:1. 4
• Children and adolescents aged 10-19 years have the highest injury rates (7.28 per 100,000 persons), followed by ages 0-9 years (5.45 per 100,000). 5
• Improper handling causes 68% of injuries, while illegal fireworks account for 32%. 4

Injury Patterns from Fireworks

• Burns affect 65.7% of patients, with most (96.5%) involving 1-10% total body surface area. 4
• Hands and fingers are injured in 32% of cases, head/face (excluding eyes) in 28.3%, and trunk in 22.4%. 4
• Contusions or lacerations comprise 34.3% of injuries. 4
• Most patients (87.5%) are treated and released, but 7.5% require hospital admission. 4

Motor Vehicle Crashes and Traumatic Brain Injury

Motor vehicle crashes during New Year's Eve require immediate structured trauma protocols with particular attention to traumatic brain injury, as alcohol intoxication is more prevalent in adolescent crash victims. 6, 7

• All MVA patients should be triaged as high-priority cases using Advanced Trauma Life Support (ATLS) principles with immediate cardiac monitoring and resuscitation equipment available. 6
• Adolescent MVA victims are more likely than adults to have used alcohol or drugs and less likely to have physical injuries from weapons. 8

Immediate Management Priorities for MVA Patients

• Perform ECG within 10 minutes of ED arrival for patients with chest pain or suspected cardiac injury. 6
• Obtain non-contrast head CT for patients with suspected TBI (GCS 14-15) and any of the following: loss of consciousness, posttraumatic amnesia with headache, vomiting, age >60 years, drug/alcohol intoxication, or GCS <15. 7
• Maintain systolic blood pressure >110 mmHg from first contact, as even a single hypotensive episode (SBP <90 mmHg) markedly worsens neurological outcomes. 7
• Establish airway control through endotracheal intubation for patients who cannot protect their airway, maintaining PaCO2 at 35-40 mmHg. 7

Psychiatric Emergencies and Behavioral Crises

Psychiatric emergencies constitute approximately 6% of all ED visits, with increased presentations during holiday periods when mental health resources are limited and social stressors are heightened. 8

• Behavioral emergencies include acute psychotic disturbances, manic episodes, major depression, bipolar disorder, and substance abuse. 8
• Adolescents are at relatively high risk of impulsive suicide attempts, with firearm access contributing to increased fatality rates. 8
• Suicidal ideation is significantly associated with cocaine use in young males presenting to psychiatric EDs. 8

Agitation Management

• For acutely agitated patients, pharmacologic intervention is necessary when verbal de-escalation fails. 8
• Restraints are indicated only when there is reasonable possibility that patients will harm themselves or others, never for punitive reasons. 8
• Security assistance is required in approximately 8.6% of ED patients, with observation needed in 57% and restraint in 26% of these cases. 8

Resource Allocation and Preparedness

Emergency departments should implement structured protocols and increase staffing for New Year's Eve, anticipating 14.9% of annual assault-related injuries occurring during holiday periods despite representing only a fraction of calendar days. 1

• The daily number of assault-related ED visits is significantly higher during holiday periods compared to baseline (p < 0.00001). 1
• Hospitals have a duty to provide adequate numbers of trained security personnel to ensure a safe environment during high-volume periods. 8
• Protocols should include immediate access to trauma surgery, psychiatric consultation, toxicology services, and social work resources. 8

Common Pitfalls to Avoid

• Do not discharge intoxicated patients without screening for dangerous behaviors (depression, suicide, homicide), as only 12.5% currently receive this critical assessment. 2
• Do not assume patients without alcohol dependence are at lower risk—they may actually have higher injury risk than dependent drinkers. 3
• Do not delay critical interventions while waiting for diagnostic studies in trauma patients. 6
• Do not rely solely on physical examination to exclude injury in intoxicated patients, as altered mental status limits accuracy. 8
• Do not dismiss mild TBI patients without proper discharge instructions and follow-up arrangements, as 18.7% will develop persistent postconcussive symptoms. 9